Monolithic Support Structure for Use in Implant-Supported Dental Devices and Methods of Making the Same

ABSTRACT

A dental device is described that comprises a monolithic support structure for use in implant-supported dental restoration applications for partially or fully edentulous patients. The monolithic support structure comprises a unitary support body with one or more teeth projections projecting from the support body, and at least one support region providing a framework for integrating discrete artificial teeth adjacent the teeth projections. An implant-supported dental device is also provided that comprises the monolithic support structure, one or more artificial teeth, and a gingival region comprised of a formable material that secures artificial teeth within the framework of the monolithic support structure.

BACKGROUND

The manufacturing of implant-supported dental restorations often includea complex series of design steps requiring multiple patient-dentistvisits, and interactions with a manufacturing dental laboratory beforecompletion of a final dental device. Implant-supported dentures mayinclude a metal support bar that supports denture teeth and acrylicgingiva, and attaches to patient implants. Design and manufacture of thesupport bar further complicates the denture making process.

Metal bars used to connect a denture to implants may stabilize andstrengthen the device to avoid breakage. However, fitting a denture ontothe bar can be difficult and often imprecise. Further, it may bedifficult to preserve the registration of the bar and the try-in dentureduring removal from a plaster model, try-in stage and/or transportationof the devices between the dentist and laboratory.

U.S. Pat. No. 6,692,254 described an apparatus and method for fasteninga denture plate with artificial teeth to a plurality of implants screwedinto the bone. A rigid metal bar is prepared that registers withimplants and is affixed to a denture plate. Screws passing through holesin the bar attach the bar and denture plate to implants are described asdistributing tooth forces among implants. US2013/0252203 describes adental bridge armature designed to be screw-fastened onto dentalimplants and includes reinforcing elements formed by long fibrespre-impregnated with resin. The armature is then included in a PMMAcoating by a pressing or injection technique.

Commonly owned US 2014/0255873, which is hereby incorporated byreference in its entirety describes an implant-supported denture devicemade from a material that may not require a separate substructure. Itmay comprise a monolithic component, with gingival and teeth regions,that attaches directly to implants. A ceramic monolithic componenthaving all ceramic teeth and gingiva lacks acrylic avoiding breakagethat may occur in traditional dentures.

SUMMARY

A dental device is described that comprises a monolithic supportstructure for use in implant-supported dental restoration applicationsfor partially or fully edentulous patients having dental implants. Themonolithic support structure comprises a unitary support body with oneor more teeth projections projecting from the support body, and at leastone support region that provide a framework for integrating discreteartificial teeth within areas adjacent the teeth projections.

An implant-supported dental device is also provided that comprises themonolithic support structure, one or more artificial teeth that arediscrete from and adjacent the teeth projections of the monolithicsupport structure. A gingival region comprised of a formable materialmay secure artificial teeth within the framework of the monolithicsupport structure. In one embodiment, a formable material alsoencapsulates the support body of the monolithic support structure andthe cervical regions of the teeth projections. The monolithic supportstructure further comprises apertures that register with a patient'simplants for attachment of the implant-supported dental device to thepatient's jaw. Implant-supported dental devices and correspondingmonolithic support structures may be designed for both partially orcompletely edentulous patients, and for one or both ridges. Moreover,the dental device may comprise a bridge for a partially edentulouspatient.

An implant-supported dental device may be digitally designed based oninformation collected from a patient regarding their oral anatomy andpositional geometry of the implant. Patient scan data or images may beused to design a monolithic support structure. The digital designcomprises a digital support body with a contour corresponding to thearch form of a patient and natural and/or artificial teeth location.Apertures are designed in registration with patient implants based ongeometric positional information regarding the implant. A digital teethdesign may be made for compatibility with any remaining dentition of thepatient, and/or with a selected dental design based on dentist input.Several digital teeth may be selected for integration with the digitalsupport structure forming the teeth projections of the monolithicsupport structure. Upon formation of a digital design and manufacturinginstructions, the monolithic structure may be milled from a single bodyof porous ceramic material and sintered into a densified monolithicsupport structure. Artificial teeth are aligned in one or more supportregions formed between teeth projections. Acrylic may be used toencapsulate the support body and cervical regions of the teethprojections, and to secure artificial teeth in place and provide anartificial gingiva. Artificial teeth may comprise a material with alower flexural strength or fracture toughness than the material of themonolithic support. Therefore, in the implant-supported device, teethprojections of the monolithic support structure may protect artificialteeth from, for example, chewing or biting forces.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention may be derived byreferring to the detailed description and claims when considered inconnection with the Figures.

FIG. 1A is a front planar view of an exemplary embodiment of amonolithic support structure.

FIG. 1B is a side-view of an exemplary embodiment of a monolithicsupport structure.

FIG. 1C is a top view of the crown side of an exemplary embodiment of amonolithic support structure.

FIG. 1D is a cross-sectional representation of the monolithic supportstructure of FIG. 1C.

FIG. 1E is a top view of the attachment side of an exemplary embodimentof a monolithic support structure.

FIG. 2 is a front planar view of an exemplary embodiment of animplant-supported dental device comprising a monolithic supportstructure.

FIG. 3A is a side buccal view of an exemplary embodiment of animplant-supported dental device which has been altered for illustrativepurposes.

FIG. 3B is a side, lingual view of an exemplary embodiment of animplant-supported dental device which has been altered for illustrativepurposes.

DETAILED DESCRIPTION

With reference to FIG. 1A, a monolithic support structure (100) isprovided. The monolithic support structure (100) may be incorporatedinto an implant-supported dental device (200), exemplified in FIG. 2,that attaches to implants in an edentulous portion of a patient's oralanatomy.

The exemplary monolithic support structure (100) illustrated in FIGS.1A-1E, comprises a support body (101), one or more teeth projections(102 and 103) that project from the support body (101), and at least oneartificial tooth support region (104, 105) adjacent the teethprojections. One or more apertures (106, 107) extending through thethickness of the monolithic support structure may be located through thesupport body (101), through one or more teeth projections (102), orpartially through a tooth projection and partially through the supportbody. Attachment means, such as screws, extend through the apertures forattachment of an implant-supported dental device to patient implants.

The monolithic support structure has an attachment side (108) orientedtoward a patient's edentulous ridge, and a crown side (109) that isopposite the attachment side (108). A lingual side (110) is proximate apatient's tongue, and a buccal side (111) is closest the inner surfaceof a patient's cheek. The support body has a width dimension extendingfrom lingual side to buccal side that may be smaller than the width ofthe patient's ridge. The contour of the support body (101) generallycorresponds to the arch form of the portion of the edentulous jaw forwhich the restoration is designed.

One or more teeth projections (102, 103) are monolithic continuations ofthe support body (101). Each tooth projection may represent a singlerestoration tooth, replacing a single natural tooth, and having ananatomical crown region (112) fully contoured with complete anatomicalfeatures on facial (buccal or labial), lingual and/or incisal/occlusalsurfaces. Anatomical features on the tooth projections may include cusps(113), ridges, fossa, grooves (114), and the like. The crown region ofeach tooth projection may be discrete from other teeth projections.Optionally, a single projection may replace two or more adjacent naturalteeth, and comprise a crown region with anatomical features consistentwith each tooth type. The one or more teeth projections may comprise acervical region (115) located between the crown region (112) and thesupport body (101), that is subgingivally located in theimplant-supported dental device.

In the implant-supported dental device (200), the crown region (112,201, and 201′) of the teeth projections (102, 103) of the monolithicsupport structure is generally exposed and extends beyond the artificialgingiva (202). The monolithic support structure (100), designed frompatient-specific data, comprises teeth projections (102, 103) that havesize, shape and anatomical features that are compatible with existingnatural dentition or artificial dentition of the patient, and thatrequire minimal finishing beyond optional staining, and/or glazing priorto making the implant-supported dental device.

The number of teeth projections (102, 103) may vary depending on thefinal implant-supported dental device. For example, the number of teethprojections on the monolithic support structure may comprise one, two,three, four, five, six, seven or eight teeth projections. In theexemplary embodiment of FIG. 1C, anterior teeth projections (102, 102′)located in the anterior region (116) of the monolithic support structuremay correspond to one or more of cuspids (canines), central incisors andlateral incisors, as found in natural or artificial dentition. Posteriorteeth projections (103, 103′) generally located in the posterior region(117) may correspond to one or more of first bicuspids (first premolar),second bicuspids (second premolar), first molar, and second molar.

The monolithic support structure comprises support regions in whichartificial teeth are aligned in the implant-supported dental device. Thesupport regions may comprise one or more anterior support regions,posterior support regions, or a support regions spanning both anteriorand posterior regions of the structure. In one embodiment exemplified inFIGS. 1A-1E, a monolithic support structure designed to restore afull-arch comprises an anterior region (116) and two posterior regions(117, 117′), each of which comprising a support region for supportingartificial teeth. In one alternate embodiment of a monolithic supportstructure designed to restore only a portion of a patient's arch, asingle support region may be provided. In a further embodiment, amonolithic support structure is designed accommodate both anterior andposterior artificial teeth within one support region that is between ananterior tooth projection (such as a central or lateral incisor) and aposterior tooth projection (such as a molar).

In one embodiment, a monolithic support structure comprising anteriorand posterior regions may comprise only posterior teeth projections, oronly anterior teeth projections. In one specific example, a full archrestoration may comprise two posterior teeth projections (e.g., a firstbicuspid and a first molar) on each side of the monolithic supportstructure, and an anterior support region with no teeth projectionsbetween the two first bicuspid teeth projections of each posteriorregion.

Upper and lower opposing monolithic support structures may compriseopposing teeth projections designed in occlusal relationship. In oneexemplary embodiment, upper and lower full-arch implant-supported dentaldevices comprising four pairs of opposing teeth projections are designedfor occlusal contact. In this embodiment, the upper arch may comprisetwo anterior teeth projections such as two cuspid teeth projections, andtwo posterior teeth projections, such as two molar teeth projections,that are in occlusion with the teeth projections of the lower arch.

A partial implant-supported dental device may comprise about 2 to about12 restoration teeth, including at least one tooth projection and atleast one artificial tooth. In one specific embodiment, a quadrantmonolithic support structure designed for a right or left side of anedentulous arch may comprise at least one anterior tooth projection, atleast one posterior tooth projection, and one or more artificial teethsupport regions for positioning artificial teeth.

At least one aperture (106, 107) extending through the thickness of themonolithic support structure is in registration with a patient'simplants. As seen in FIGS. 1C, 1D and 1E, at least one aperture (106,107) may extend through the support body in an anterior region, aposterior region, or may extend through one or more teeth projections.In some restorations, a patient's implant placement in an anteriorregion requires an aperture to be located through an anteriorrestoration tooth of an implant-supported dental device,disadvantageously requiring a reduction of an artificial denture toothto accommodate the aperture. In this embodiment, one or more teethprojections may be advantageously designed as the restoration tooth(teeth) so that the aperture passes through the sturdy tooth projectioninstead of an artificial denture tooth, thus, eliminating the need tomodify an artificial denture tooth to accommodate the aperture.

The support body may optionally comprise at least one aperture flangeregion (119), or at least one guide cylinder (120) encircling theaperture, or both. The aperture flange region and/or guide cylinder mayalso be a unitary, monolithic projection from the support bodycomprising the same material as the monolithic support structure. Tominimize the overall buccal-to-lingual dimension, or width, of thesupport body, the aperture flange region (119) surrounds an aperture,where placement of the aperture extends beyond the predominant widthdimension and contour of the support body.

The guide cylinder (120) comprises a hollow cylindrical projection onthe attachment surface of the support body, as exemplified in FIGS. 1A,1B, and 1D. The geometry of the guide cylinder (120) is designed basedon the positional orientation of the implant having a geometry andorientation matching the implant. An attachment means, such as a screwhaving a geometry and size compatible with the patient's implant, isinserted into the aperture on the crown side, passing through thesupport body, and optional guide cylinder, to attach the finalimplant-supported dental device to the patient's implants.

Optionally, an insert, such as an implant-compatible non-engagingabutment insert that is compatible with the implant system of thepatient, may be placed within the guide cylinder and may abut theimplant upon attachment of the implant-supported dental device. Theinsert may be comprised of a metal, such as titanium. In one embodiment,an insert (205), may be secured in the implant-supported device by theformable material (202) that encapsulates the monolithic supportstructure. Optionally, an insert comprises an insert flange (206) havinga diameter larger than the guide cylinder to maintain the insertposition within the guide cylinder. An attachment means, such as a screwthat is compatible with the insert and implant system, passes throughthe insert within the guide cylinder, connecting to the implant forattachment of the implant-supported dental device.

As exemplified in FIG. 1D, the support body (101), the one or more teethprojections (102, 103), and optional guide cylinders (120), form aunitary, monolithic support structure. By unitary is meant that themonolithic support structure is constructed as one piece. FIG. 1Dillustrates a representative cross-section (118) (shown as line A-A′ inFIG. 1C) taken through a portion of a monolithic support structurethrough teeth projections (102, 103), aperture (107), guide cylinder(120), and support body (101) showing a continuous material that extendsthrough the shaped body from the attachment side to the occlusal surfaceof the tooth projection.

Processes for manufacturing the monolithic support structure mayinclude, but are not limited to automated manufacturing processes, suchas an additive or subtractive processes, injection molding, or casting.Rapid manufacturing processes, including subtractive or additivemanufacturing processes may be used. Subtractive manufacturing processesinclude, carving, grinding or milling, or CNC milling or machiningprocesses, wherein the monolithic support structure is made from asingle piece of material, such as a single ceramic monolithic block. Forexample, a 5-axis Haas milling machine (Hass Automation) may be used toform a monolithic support structure from a single ceramic block ofmaterial. Additive manufacturing processes may also be used to form amonolithic support structure, including technologies such as 3D printingtechnologies, stereo lithography, selective laser sintering (SLS), andfused deposition modeling.

The monolithic support structure may be made from a hard, durablematerial, or a material having mechanical properties such as highflexural strength, wear resistance, and/or fracture toughness such as aceramic material. Optionally, the monolithic support structure issubstantially free of metal, and optionally, the monolithic supportstructure is substantially free of titanium.

Ceramic materials include dental ceramics suitable for use in dentalrestorations, including zirconia, alumina, titanium dioxide, andmixtures thereof. Zirconia ceramic materials may comprise zirconia,stabilized zirconia, such as tetragonal stabilized zirconia, andmixtures thereof. Stabilized zirconia may include yttria-stabilizedzirconia, such as those materials commercially available from Tosoh USA,that are suitable for use dental restoration applications.Yttria-stabilized zirconia may comprise about 3 mol % to about 5 mol %yttria, or about 2 mol % to about 7 mol % yttria. Suitable ceramicpowders may also comprise zirconia stabilized with about 3%, 5% or 7% bymass yttria, such as 3Y-TZP available through Tosoh.

Ceramic powders made of the above formulations may be processed intoceramic forms suitable for use in making dental restorations by knownmethods. Ceramic powders may be pressed, for example, by biaxial oriso-static pressing, into millable forms, and the ceramic powders mayoptionally comprise binders and processing aids to facilitate blockformation. Optionally, ceramic powder may be processed by slip castingprocesses including, but not limited to, processes described in U.S.Patent Publication Nos. 2009/0115084; 2013/0231239; and 2013/0313738;and U.S. Pat. No. 8,298,329, all of which are incorporated by referencein their entirety. Ceramic forms, such as yttria-stabilized tetragonalzirconia sold as blocks, discs, or blanks, having a size and shapesuitable for making a full or partial arch monolithic structure, andsold under the trade name BRUXZIR (Glidewell Laboratories) may besuitable for use herein.

In one embodiment, the monolithic support structure is shaped as aporous body from a green-state or partially sintered ceramic block. Inone embodiment, green-state material is partially sintered to abisque-state that is sufficiently hard to retain its structure duringgrinding or milling into a monolithic support structure design, and softenough to allow rapid shaping by a milling tool. CAD/CAM millingprocesses may be used to shape the monolithic support structureaccording to milling instructions based on a digital design. The porousor partially sintered body is then sintered at high temperature. Bisquestage ceramic materials include ceramic materials that have beenpartially densified or heated for example, to remove water or binder,while retaining some porosity and having a density below the maximumtheoretical density of the material. In some embodiments, bisque stageceramics are formed by heating green ceramic materials at a temperaturein the range of about 850° C. to about 1200° C. for about 1 to 2 hours,or until a desired density is achieved. In some embodiments greenceramic materials fabricated from yttria-stabilized tetragonal zirconiapolycrystals doped with alumina (BruxZir® zirconia, Glidewell DentalLaboratories) may be heated at a temperature in the range of about 1020°C. to about 1050° C., for about 24 hours to about 60 hours to formbisque ceramic materials having a density in the range of about 3.15 toabout 3.35 g/cm³. Bisque stage ceramics include materials having adensity that is approximately 50% to about 90% of the maximumtheoretical density of the ceramic material. Zirconia-containing bisquestage ceramics include those that have a density of about 3.1 to about3.4 g/cm³, and which can be densified to a density greater than or equalto about 6 g/cm³. In some embodiments, a bisque stage ceramic materialcomprises yttria-stabilized tetragonal zirconia and has a density in therange of about 6.01 g/cm³ to about 6.1 g/cm³ after sintering at atemperature in the range of from about 1350° C. to about 1600° C.

Green-state or partially sintered ceramic blocks having known shrinkagerates can be fabricated in CAD/CAM systems by designing the monolithicsupport structure to a dimension larger than the final sinteredstructure by a scaled factor that anticipates a highly predictablereduction in size upon sintering to full density. A subsequentlysintered monolithic support structure having reduced in size from thebisque stage structure conforms to the patient-specific design.

Advantageously, sintered yttria-stabilized zirconia materials suitablefor use herein may comprise high light transmission in about the 500-800nm wavelength range. Moreover, sintered ceramic materials for use inmaking monolithic support structures have high wear resistance, fracturetoughness, and high flexural strength when tested by a flexural strengthtest method for zirconia materials according to the methods outlined inISO 6872:2008, measured and calculated according to the 3 point flexuralstrength test described for Dentistry—Ceramic Materials. For example,ceramic materials used herein may have a flexural strength value greaterthan about 650 MPa, or greater than about 800 MPa, when tested accordingto the above test method.

The ceramic blocks may be shaded to achieve the color of natural orartificial dentition. Coloring agents may be incorporated during blockformation to produce a shaded monolithic support structure having teethprojections that match the shade of natural dentition or artificialteeth without further colorization. U.S. Patent Publication No.2013/0231239, incorporated by reference herein, in its entirety,describes methods for coloring ceramics by colloidal dispersion andcasting the ceramics by slip casting methods. A further example includescommonly owned, U.S. Patent Publication No. 2014/0109797, which teachesmethods for making colored ceramic powder, formed into green stateceramic bodies by press manufacturing processes, is also incorporated byreference herein in its entirety. Alternatively, or additionally, aftermilling or grinding, monolithic structures may be colorized and/orglazed in the bisque or sintered state, for example, by methods known inthe dental industry, or by processes described in commonly owned U.S.Patent Publication No. 2014/0101869, which is hereby incorporated byreference in its entirety.

The crown regions of teeth projections may be shaded or colorized tomatch the shade of a selected artificial tooth which will be used in theimplant-supported dental device, or to match the shade of anysurrounding or opposing natural dentition. The support body may beshaded or colorized a pink or flesh-tone shade to reduce visibility ofthe monolithic support structure through the formable material in whichit is encapsulated. Ceramic powders, ceramic materials, or themonolithic support structure, may be shaded or colorized to match acommercially available artificial tooth, for example, in a Bioform shade(Dentsply International Inc.) or VITA shade (such as Vita Classic ShadeA1, A2, A3, etc., Vita Zahnfabrik).

An implant-supported dental device (200), exemplified in FIG. 2, is acomposite of the monolithic support structure, artificial teeth, andoptionally, artificial gingiva. The monolithic support structureprovides a framework for integrating discrete artificial teeth (203,204), such as commercially available denture teeth, and artificialgingiva (202) to form the implant-supported dental device.

FIGS. 3A and 3B depicts an exemplary implant-supported dental device(300) in which a portion of the artificial gingiva (302) has beenremoved, for illustrative purposes only, to show alignment of artificialteeth (303, 304) in anterior and posterior artificial tooth supportregions (305, 306) between teeth projections (301, 301′) and adjacentthe support body (307) of the monolithic support structure. Themonolithic support structure comprises two anterior teeth projections(cuspids) (301), two posterior teeth projections (molars) (301′), andguide cylinders (308) surrounding apertures.

Shown in the embodiment of FIGS. 3A and 3B, discrete artificial teethcomprise two central incisors (303) and two lateral incisors (303′), inthe anterior region, and in posterior regions, comprise bicuspids(1^(st) and 2^(nd)) (304). Placement of teeth projections in bothanterior and posterior regions of the monolithic support structure maybalance and distribute contact between anterior and posterior teethprojections maintaining vertical dimension of the upper and lower jaw,and protecting the artificial teeth from wearing away.

In FIGS. 3A and 3B, the guide cylinders (308) comprise metal inserts(309) that guide an attachment means, such as a screw, for attaching theimplant-supported dental device to a patient's implants.

An artificial gingiva (202, 302) may be formed from a formable material,in surrounding relationship to the support body and the cervical regionof the teeth projections. The formable material may comprise an acrylic,such as a shaded polymethylmethacrylate (PMMA), and may also secureartificial teeth (203, 204) within denture support regions of themonolithic support structure. The support body (307) of the monolithicsupport structure may be partially or fully encapsulated by the formablematerial (302), maintaining aperture openings, for example by use of ablocking material. The cervical region of teeth projections (301, 301′)and artificial teeth (303, 303′, 304) encapsulated by the formablematerial, are thus, subgingivally located in the implant-supporteddental device. The crown regions of teeth projections are exposedextending beyond the formable material.

Artificial teeth for use in the implant-supported dental device maycomprise commercially available artificial teeth, such as denture teethsold under the trade names, Kenson and Vita, handmade teeth, and thelike. Known denture teeth made of a material such as acrylic, or PMMA,or an acrylic composite are provided in a wide variety of sizes, shapes,and shades. In one embodiment, artificial teeth are selected from adigital teeth library of a denture design software program whendigitally designing the monolithic support structure, ensuringappropriate spacing of the artificial teeth in the implant-supporteddental device.

In one embodiment, an implant-supported dental device comprisesartificial teeth that comprise a first material having differentmaterial properties than a second material used to form the monolithicsupport structure. In a specific embodiment, the monolithic supportstructure comprises a material having higher wear resistance, flexuralstrength and/or fracture toughness values than the material of theartificial teeth, and or the gingiva region. In one embodiment, themonolithic support structure comprises a ceramic material having aflexural strength value greater than about 650 MPa, or greater thanabout 800 MPa, when tested in accordance with ISO-6872:2008, which isgreater than the flexural strength of the material used to form theartificial teeth.

Disadvantageously, denture teeth made of soft material are prone to wearand breakage in traditional dentures during normal use by a patient.Artificial teeth present over the entire arch, or in specific anterioror posterior locations, for example, may break or wear from contact orbite force during biting, chewing, and/or occlusion. In one embodiment,artificial teeth may be protected from wear for example, in lateralexcursion, by placement of teeth projections that bears the forces ofnormal wear. While not wishing to be bound by theory, the materialproperties of the monolithic support structure may protect artificialteeth from chipping, wear, breakage and/or loosening of the artificialteeth, in some embodiments by distributing contact and bite forcepredominantly on or between teeth projections and/or natural dentition.

A method is also provided for making the implant-supported dentaldevice. In one method, a method comprises forming a dental device waxset-up comprising a sintered ceramic monolithic support structure thatcomprises teeth projections and artificial teeth support regions betweenthe teeth projections. The method further comprises obtaining artificialteeth, setting the artificial teeth in wax in the artificial toothsupport regions of the monolithic support structure, and forming a waxgingiva. Optionally, inserts may by placed into cylinder guides on themonolithic support structure.

The method may further comprise forming a mold of the wax set-up forcasting the final implant-supported dental device. Traditionalmold-forming techniques and materials known in the dental industry maybe used to make a mold of the set-up. By way of example, and not belimitation, mold making materials include sodium alginate, rubber,stone, hydrocolloid, polyether and silicones including condensationcured silicones and addition-cured silicones, including polyvinylsiloxane (PVS). The set-up may be pressed to form a mold. Alternately,the set-up may be placed in a secondary container and a liquid formablematerial may be poured around the set-up. Replicas or block-out materialmay be placed in the apertures to prevent impression material fromblocking the holes.

The method further comprises placing the wax set-up in the mold, andremoving the wax, for example, by melting and pouring it out, leavingthe artificial teeth and monolithic support structure in position withinthe model. A formable material suitable for forming the actual gingivalportion of a denture, such as acrylic, may be poured, injected or packedinto the mold. Upon solidification, an implant-supported dental devicecomprising a monolithic support structure, artificial gingiva andartificial teeth that are held in place by the acrylic, is formed.

A method is provided for designing the monolithic support structure. Inone embodiment a method is provided that comprises obtaining digitalpatient specific information of a patient's oral anatomy and implantinformation of an implant implanted in the patient's jaw; forming adigital model of the patient's oral anatomy from the patient specificinformation; creating a digital design comprising a digital supportstructure comprising digital teeth and apertures, based on the digitalmodel of the patient specific information and implant information;forming digital instructions readable by an automated manufacturingmachine to make the digital design; and utilizing the digitalinstructions in an automated manufacturing process to make a monolithicsupport structure.

A computer-implemented method is provided for making the digital modelof the monolithic support structure from patient specific information.One or more electronic images capturing a patient's oral situation isobtained as digital data, and may comprise information about a patient'sedentulous ridge or soft tissue in need of dental restoration,surrounding dentition, opposing dentition, occlusal relationship betweenjaws, and implant position for implants implanted in the jaw of apatient. Optionally, the digital data may be captured as images fromdirect intraoral scanning of a patient's anatomy, for example, obtainedby a dentist using commercially available intraoral scanners.

Scans may also be obtained from physical impressions taken bytraditional dental methods using trays and commercially available dentalimpression materials. Electronic images may also be obtained forexample, by scanning models of a patient's anatomy, for example with atable-top or box scanner commercially available for use with dentalapplications. Physical models can be made from a cast of an impression,for example in stone, plaster or polymeric material. A temporary,try-in, or permanent denture previously made for a patient may also beused as a model to obtain patient specific information. A plurality ofscans may be merged into a digital model of the restoration jaw, andoptionally, the opposing dentition or jaw.

Computer-implemented systems suitable for designing the monolithicsupport structure, and optionally, also the implant-supported device,include commercially available CAD systems having dental design computerprograms for designing patient-specific, implant-supported denturedevices, bars and bridges, and/or full mouth contour restorations.Dental design systems, such as those sold under the trade name 3Shape,may be suitable for use herein. Other method, processes or systems, thatmay be used in whole or in part, are described in commonly owned U.S.patent application Ser. Nos. 14/142,382; 14/142,393; and 14/200,689,which are hereby incorporated in their entirety.

Digital teeth arrangements may be obtained, for example, by scanningexisting dentures or wax set-ups. Alternatively, digital teetharrangements may be designed based on the digital model of the patient'soral situation. Digital teeth may be selected from a digital toothlibrary having a size and shape compatible with any natural remainingdentition. Digital teeth are aligned to the patient's digital model, theposition of implants and any surrounding or opposing dentition.

A digital support structure is designed in supporting arrangement withthe digital teeth design, and also has a shape corresponding to thecontour of a portion of the digital model of the patient's jaw in needof restoration. Digital apertures are designed on the support bar thatalign with the position and orientation of the implants.

In one embodiment, an entire set of teeth is digitally arranged on thedigital support bar, and the digital teeth design is merged with thedigital support bar. Subsequently, a portion of the digital teeth areremoved leaving only digital teeth that correspond with teethprojections merged onto the support bar. A digital monolithic supportstructure is created that comprise the support bar and merged teeth fromwhich instructions may be created to be used by an automatedmanufacturing machine.

In another embodiment, a digital support structure is digitallydesigned, and one or more digital teeth are selected and aligned on thedigital support bar. The selected digital teeth correspond to teethprojections on the final monolithic support structure. The digital teethare arranged on the digital support structure and merged with thesupport structure to form a digital monolithic support structure.

The digital teeth design and the digital support structure design maycomprise one or more digital files, and where necessary merged as asingle digital design file. The merged file of the digital teetharrangement design and the digital support structure may be convertedinto output files, and/or instructions for use in automatedmanufacturing processes. Files of the digital support structurecomprising digital teeth in the form of one or more instruction file(s)may be sent to a rapid manufacturing machine, such as a mill, to producethe monolithic structure.

As will be apparent, the features and attributes of the specificembodiments disclosed herein may be combined in different ways to formadditional embodiments that fall within the scope of the presentdisclosure. Alternate implementations of processes are included withinthe scope of the embodiments described herein in which elements andfunctions may, for example, be deleted or executed out of the orderdisclosed. Method and process steps for the digital designs disclosed,may be embodied in software code modules executed by one or more generalpurpose computers or processors, such as those known for use in dentaldesign and automated manufacturing processes. Although this inventionhas been disclosed in context of certain specific embodiments, it willbe understood by those skilled in the art, for example, that the presentinvention extends beyond the specific disclosure to include obviousequivalence, modifications or alternate uses.

We claim:
 1. A dental device comprising: a monolithic support structurecomprising a support body; one or more teeth projections extending fromthe support body; at least one artificial tooth support region adjacentthe teeth projections; and one or more apertures extending through thesupport body.
 2. The dental device of claim 1, wherein the monolithicsupport structure comprises a ceramic material.
 3. The dental device ofclaim 1, wherein the monolithic support structure comprises zirconia. 4.The dental device of claim 1, having at least one anterior toothprojection and at least one posterior tooth projection.
 5. The dentaldevice of claim 1, wherein each of the teeth projections comprises acrown region that comprises a substantially completed restorationdesign.
 6. The dental device of claim 5, wherein the crown regioncomprises a shade that corresponds to a Vita shade.
 7. The dental deviceof claim 1, wherein the monolithic support structure further comprisesone or more cylindrical guides encircling the one or more apertures. 8.The dental device of claim 1, wherein the monolithic support structurehas a contour of a patient's full arch form, and comprises an anteriorartificial tooth support region between two posterior artificial toothsupport regions.
 9. The dental device of claim 8, wherein each posteriorartificial tooth support region is between an anterior tooth projectionand a posterior tooth projection.
 10. An implant-supported dental devicecomprising a monolithic support structure comprising a support body, oneor more teeth projections extending from the support body, one or moreartificial teeth support regions adjacent the teeth projections, and oneor more apertures extending through the support body; at least oneartificial tooth that is aligned in an artificial tooth support regionadjacent at least one of the teeth projections; and a formable materialthat at least partially encapsulates the monolithic support structure toform a gingival region.
 11. The implant-supported dental device of claim10, wherein the at least one artificial tooth is affixed in one of theartificial teeth support regions of the monolithic support structure bythe formable material.
 12. The implant-supported dental device of claim10, wherein the formable material comprises an acrylic.
 13. Thecomposite dental support device of claim 10, wherein one or more teethprojections comprise a crown region having a shade that corresponds to ashade of the at least one artificial tooth.
 14. The implant-supporteddental device of claim 10, comprising two anterior teeth projections andtwo posterior teeth projections.
 15. The implant-supported dental deviceof claim 10, wherein the monolithic support structure is formed from aceramic material having a higher flexural strength than a material fromwhich the at least one artificial is formed.
 16. The implant-supporteddental device of claim 10, comprising an upper arch and a lower arch,wherein teeth projections on the upper arch and lower arch are incentric occlusion.
 17. A method of making a monolithic support structurecomprising the steps of: obtaining digital patient specific informationof a patient's oral anatomy and implant information of an implantimplanted in the patient's jaw; forming a digital model of the patient'soral anatomy from the patient specific information; creating a digitaldesign comprising a digital support structure comprising digital teethand apertures, based on the digital model of the patient-specificinformation and implant information; forming digital instructionsreadable by an automated manufacturing machine to make the digitaldesign; and utilizing the digital instructions in an automatedmanufacturing process to make a monolithic support structure comprising,as a single, unitary body of material, a support body, one or more teethprojections extending from the support body and at least one artificialtooth support region adjacent the teeth projections.
 18. The method ofclaim 17, wherein the automated manufacturing process comprises amilling process.
 19. The method of claim 18, comprising milling themonolithic support structure from a monolithic block of ceramicmaterial.
 20. The method of claim 17, wherein the automatedmanufacturing process comprises an additive manufacturing process tomake the monolithic support structure as a unitary body.